Association Between Thiopurine Use And Nonmelanoma Skin Cancers In Patients With Inflammatory Bowel Disease: A Meta-analysis

E-mail: v.subramanian@leeds.ac.uk Received 13March2013; Accepted 5November2013 Advance online publication 14January2014 OBJECTIVES: Thiopurines are the mainstay of treatment for patients with inflammatory bowel disease (IBD). Thiopurine therapy increases the risk of nonmelanoma skin cancers (NMSCs) in organ transplant patients. The data on NMSC in patients with IBD on thiopurines is conflicting. METHODS: We searched electronic databases for full journal articles reporting on the risk of developing NMSC in patients with IBD on thiopurine and hand searched the reference lists of all retrieved articles. Pooled adjusted hazard ratios and 95% confidence intervals (CIs) were determined using a random-effects model. Publication bias was assessed using Funnel plots and Egger’s test. Heterogeneity was assessed using Cochran’s Q and the I2 statistic. RESULTS: Eight studies involving 60,351 patients provided data on the risk of developing NMSC in patients with IBD on thiopurines. The pooled adjusted hazards ratio of developing NMSC after exposure to thiopurines in patients with IBD was 2.28 (95% CI: 1.50 to 3.45). There was significant heterogeneity (I2=76%) between the studies but no evidence of publication bias. Meta regression analysis suggested that the population studied (hospital-based vs.

today announced that it has purchased IP and signed a collaboration agreement with Dr. C.P. Swain for the joint development of an innovative laparoscopic nitinol based compression anastomosis solution for Bariatric surgery. Professor Paul Swain is Professor of Gastrointestinal Endoscopy at Imperial College, London University, UK. Professor Swain is widely published in the area of gastroenterology, with over 180 publications on areas such as endoscopy, gastrointestinal bleeding and technical advances and devices for endoscopy. “I am thrilled to be working again with Gavriel Meron and the novoGI development team to provide a unique solution for the growing need for a simpler and safer bariatric surgical procedure,” commented Dr. Swain. “Bariatric surgery often is the best path for resolving obesity and Type 2 Diabetes, and we believe that our innovative solution may significantly improve outcomes and quality of life, thereby becoming the standard of care worldwide.” “We are delighted to be collaborating with Dr. Swain. A prototype has already been successfully tested in pre-clinical studies and we look forward to jointly developing this solution,” said Gavriel D. Meron, President and Chief Executive Officer of novoGI. “We see this agreement as another important step in expanding our offerings in line with our focus on advancing patient care and seeking better outcomes through our comprehensive approach to GI disease management.” About Dr. Christopher Paul Swain Professor Paul Swain trained in Oxford and London University and specialized in gastroenterology, doing his MD on the use of therapeutic endoscopy for the treatment of gastrointestinal bleeding.Subsequent posts included a DHSS-funded Clinical Research Fellowship to study the effect of lasers in gastrointestinal hemorrhage. In 1987, he was appointed as Senior Lecturer and Consultant in Gastroenterology at the Royal London Hospital. In 1999, he was appointed to become Professor of Gastrointestinal Endoscopy to London University.In 2003, he moved to Imperial College in London University. Professor Swain has contributed chapters to key clinical textbooks such as the Textbook of Gastroenterology (Ed: T Yamada) and Clinical Gastroenterology, Endoscopy: New Techniques in Diagnosis and Therapy (Ed: H D Allescher and M Classen).

Gastroenterology experts call for 24-hour service in all UK hospitals

The call comes after a UK-wide audit from the society revealed that nearly half of UK hospitals do not provide an out-of-hours endoscopy service, despite 60% of acute upper gastrointestinal bleeding episodes occurring out of normal working hours. According to the British Society of Gastroenterology (BSG), more than 700 lives could be saved each year if all hospitals offered a 24-hour service. Addressing a meeting at Number 11, Downing Street yesterday to raise awareness of gastroenterological conditions, BSG president, professor Chris Hawkey, said: Our audit has shown that about 80,000 patients a year are admitted with gastrointestinal bleeding, which has an 8% mortality rate. Yet only 55% of trusts at the moment provide a comprehensive out-of-hours GI bleeding service we need to get this to 100%, he added. The BSG is also calling for six new standards of care for patients with inflammatory bowel disease to be implemented by all UK commissioners by October 2010. Readers’ comments (1) Anonymous | 26-Jun-2009 8:24 pm The B.S.G. is correct in calling for a 24/7 service. In my experience, during almost 20 years of endoscopy nursing, most bleeds and other emergencies occurred outside of the normal working day. The equipment is available and I believe that the service should be funded. Patients deserve prompt effective diagnosis and treatment.